I
particularly appreciated the population growth information as it
related to the amount of sq. ft. that would be needed to support
that growth

Networking

UM
Health Presentation and Leo A Daly

The
venue

Good
variety of speakers

All
the talks were interesting. I particularly learned the most from the
Prefab Components Case Study

Reuniting with healthcare community

It
was my first healthcare conference. It was overwhelming, but most
interesting

Lots
of great, useful information I would like to reference in an
upcoming meeting

I
have a huge presentation coming up and would love to include some of
the amazing insights you provided

Takeaway Messages

March 06,
2019 - Miami, FL

Reported by Richard Westlund, a freelance
writer based in Miami. Westlund specializes in business,
medicine, real estate, human resources, corporate leadership,
law, finance, education, aviation, technology, and other topics.
He also founded the South Florida Medical Review, the nation's
first regional medical-business newspaper.

Future of
Ambulatory
Healthcare
Delivery

Ben
Riestra,
Chief
Ambulatory
Operations
Executive
and Chief
Administrative
Officer of
The Lennar
Foundation
Medical
Center at
UHealth, the
University
of Miami
Health
System

Don’t do
your
planning
in the
conference
room —
go out
and talk
to
people
on the
floors.

Improve
the
patient
experience
through
strategies
such as
reducing
check-in
and wait
times
and
making
parking
convenient.

Be
flexible.
Plan
with a
5- to
7-year
time
horizon.

Adopt
the
principle
of
continuous
improvement.
Daily
huddles
can help
your
team
deliver
better
care.

With
design
and
construction,
nothing
should
say
“ugly
and
sterile.”
Make it
pleasing,
convenient
and fun.

Improving
clinical
workflows,
so
patients
can move
in and
out more
quickly,
is a
great
strategy
for
reducing
wait
time in
the
examination
room.

What’s Driving Demand for
Healthcare Facilities

Healthcare is very regionally driven.

Emergency department (ED) visits are
rising while inpatient admissions are flattening. 64% of
admissions start in the ED.

Since 1990, the U.S. has 500 fewer
hospitals and 100,000 fewer beds.

Outpatient visits are skyrocketing.

About 16% of a doctor’s patients are new
and 84% are recurring.

More physicians are employees and fewer
are independent.

Physicians drive the patient experience
and healthcare revenues, while hospitals are integrators of
services. The average net revenue generated by a physician
is $2.378 million.

As the U.S. population gets older,
physician visits will increase. The U.S. average is 282
annual visits per 100 people, but in Florida it is 341.2
visits. A University of Florida population forecast projects
a 31.6% increase in doctor visits from 2020 to 2045.

An estimated 1.4 to 2.6 million square
feet of additional outpatient facilities will be needed to
accommodate the volume.

Most patients over 65 don’t come alone on
visits, and this is influencing facility design,
transportation and other factors.

About 30% of hospital space will be
functionally obsolete in the future.

The 2014 edition of the FGI guidelines
are now in use in most states, while the 2018 edition is
being referenced in seven states. The 2022 guidelines will
focus on going beyond the fundamentals. Visit
fgiguidelines.org for the latest information.

FGI does interpretations, such as on the
minimum square-footage requirements of a low-acuity patient
pod in the ED. The Institute also is looking at palliative
care facility standards and behavioral health units in the
ED.

It’s important to take resiliency and
business continuity into account in design, particularly in
relation to tornadoes, hurricanes and long-term climate
change. Be prepared for community residents who plan to
shelter in place.

When clinical telemedicine services are
provided, it’s important to consider the environment as well
as the facility space.

For instance, are you achieving
accurate skin tone and facial features on display monitors;
avoiding glare; protecting patient privacy; or accounting
for acoustics, lighting and even the color of walls (not
yellow!)?

Avoiding violations is crucial because
healthcare providers that receive federal monies must comply
with CMS Conditions of Participation or be subject to
damages and fines under the federal False Claims Act of
1875.

Compliance in leased buildings can pose
issues for healthcare tenants, as responsibilities may
involve the owner and even other tenants. For example,
Peterkin shared how one co-tenant shut a building’s
electrical system down over the weekend, resulting in the
medical tenant losing $100,000 in refridgerated drugs.

If you hire a contractor, service
provider or have “guests/invitees,” be sure to understand
the applicable provisions in the lease document.

In new construction, spell out
responsibilities for the shell contractor, and try to reduce
logistical issues if another contractor is doing the
interior build-outs.

Be aware that change orders can have many
ramifications for other areas of the building, including
utilities, storage areas and medical gases.

If there is any chance of a new facility
providing ambulatory healthcare, plan ahead. For instance, a
two-story building might require dual elevators that are
large enough to accommodate patient beds.

Let strategic planning drive
construction, rather than the other way.

Construction costs are escalating, so
take that into account when planning ahead.

Case Study:
A Systems
Approach to
Healthcare
Redesign

Don’t
accept a
napkin
sketch
as the
starting
point
for a
healthcare
design.
Instead,
expect
your
designer
to dig
into the
situation,
look
beyond
the
distractions
and
solve
the
right
problem.

A good
starting
point is
workload
volumes
and
forecasts
for
future
population
growth
and
usage.
That can
determine
how many
rooms
will be
needed.

Identify
wasteful
processes
before
designing.
For
instance,
a
bottleneck
in the
ER might
be a
sign
that
more
inpatient
beds are
needed
rather
than a
larger
ER.

Get
input
from
physicians,
nurses,
equipment
managers
and
other
staffers
before
laying
out the
spaces.
Strive
for
consensus.

Consider
prefab
construction
techniques.

Explore
a
configurable
family
care
system
to meet
the
needs of
patients
of
different
generations.
For
instance,
a room
might
have a
pull-down
bed or a
panel
that
turns
into a
desk of
a table
for
dining.

Be
innovative.
If
Amazon
can
deliver
a salad
from
Whole
Foods to
a
patient
room,
perhaps
a drone
port
would be
a nice
feature
for
improving
the
patient
experience.

A CBRE
survey
of
healthcare
investors
and
developers
found
demand
for
wellness
centers
at the
top of
the
list.
Demand
was
lower
for
long-term
acute
healthcare
facilities.South
Florida
has seen
an
increase
in care
closer
to
neighborhoods.
Outpatient
services
is where
the
growth
is
occurring,
including
imaging
centers
and
standalone
emergency
rooms.

Rendina
is
focusing
at
redevelopment
projects.
A lot of
retail
malls
want to
incorporate
a
medical
office
use.

Health
system tax
status
is not a
big
concern
for many
communities
that
want to
bring in
healthcare
uses.

Investors
like the
medical
office
market,
even
with
lower
cap
rates
and
higher
purchase
prices.
There is
more
money
chasing
quality
assets
than
there is
supply.

If
Florida
repeals
its
Certificate
of Need
requirements,
the
state
could
see a
number
of
“micro
hospitals.”

However,
demand
for
multifamily
and
condo
projects
in South
Florida
has
driven
up land
prices,
making
it
difficult
to
develop
new
medical
office
facilities.

Care on
demand,
including
telehealth,
may be a
cost-effective
solution
for
serving
patients
in
high-priced
real
estate
markets
like
Miami’s
urban
core.

Case Study:
Real Time
Savings with
Prefabricated
Components
on Two South
Florida Bed
Tower
Expansions

Because
prefabrication
work is
done in
a
controlled
environment,
it
typically results
in time
savings,
higher
quality
environments
and
safer
job
sites.

Prefab
components
may
include
bathroom
PODS,
exam
room
PODS,
headwalls,
modular
casework,
and
overhead
MEP
racks,
to name
a few
examples.

Prefab
addresses
labor
shortage
problems
in local
markets.

Prefab
components
can be
produced
in
advance
and
shipped
to the
job site
ready
for
installation.

On one
tight
South
Florida
job
site,
prefab
components
were
installed
in 3.5
weeks,
versus
the four
months
it would
have
taken
using a
traditional
approach.

DPR is
now
working
on
prefab
underground
electrical
modules
and
prefab
central
energy
plants
as a way
to
eliminate
on-the-job
labor
and save
time.

(Left)
Daniel
Berger,
Superintendent,
DPR
Construction

(Right)
Kevin
Dean,
Project
Executive,
DPR
Construction

Tips, Tricks
of the Trade
& Traps to
Avoid – In
the Field
Experts

(Left to
Right)
Dave
Blackwell,
Chayla
Brown, Paul
Swan

Dave
Blackwell,
Camfil:

For
every $1
a
hospital
spends
on air
filtration,
$7 is
spent on
fan
energy
to push
air
through
that
filter.
Buying
energy-efficient
air
filters
may be
more
expensive
upfront,
but that
price
becomes
a wash
as they
reduce
that
energy
cost.

Don’t
change
air
filters
based on
the
calendar
year.
ASHRAE
recommends
filters
be
changed
based on
pressure
rather
than
frequency.
That
means
you will
buy
fewer
filters,
install
them
less
frequently
and have
fewer to
throw
away.

Chayla
Brown,
nora systems
Inc.:

Flooring
installers
may not
take
enough
time on
the
details
and
corners,
so have
the
general
contractor
ask the
flooring
contractor
to
provide
a mockup
to show
you how
the
floor
will
look
once
installed
in a
space.

Be sure
you
understand
the type
and
compound
of
subflooring,
and ask
your
flooring
contractor
to
disclose
the
amount
and type
of
patching
done to
ensure
you have
a good
substrate.

When
wheel
marks or
other
indentations
appear,
it is
more
likely
to be a
displacement
of
underlayment
rather
than of
the
adhesive.
Be sure
the
patch
has
enough
compressive
strength.

Paul Swan,
ASSA ABLOY:

Put the
door
design
into the
construction
documents.
When
value
engineering
occurs,
the end
result
is not
the
same,
and you
don’t
want to
scramble
to see
how
things
function
at the
end.

Think of
economies
of scale
when
selecting
door
security
products.
When we
price a
project
as a
total
package,
you get
a more
competitive
price
and TCO,
so think
of a
total
door
opening,
not just
the
frame,
hinges
and
doorstop.